Understanding California health insurance plan options

California Medical Insurance:  A quick guide to understanding how to make your decision


If youíve spent some time on our website at www.plansforhealth.net you know youíve harnessed a power tool to quickly compare major California insurance carrier plans, benefits, and pricing all instantly and at your fingertips.  So, now that you have pricing and benefit data how do you use the decision in combination with your personal situation pick the right plan.  Letís spend a few minutes considering some of the key factors to think about when evaluating your next California health insurance plan.

DEDUCTIBLE VS. PREMIUMS:      A major factor in the monthly premium cost of a health insurance plan is the deductible.  An insurance plan, you certainly have noticed if youíve already run your instant quote, contains higher premiums with lower deductible insurance coverage.  What you need to pay attention to is typically how much of your plan deductible might you spend each year.  If you are comparing the difference in cost between a $250 deductible plan vs. a $1000 deductible plan and the monthly premium for the $250 deductible plan is an extra $300, youíll be spending an extra $3600 in premiums to save the $750 difference in deductible size.  This doesnít make sense to purchase unless you really need a tax deduction.

WHERE YOU MIGHT CUT BACK:    Consider how many office visits you and your family have per year.  About half the population doesnít use their insurance plan or visits the doctor only for very minor medical expenses.  If you are one of those people who uses the doctorís office very infrequently you might consider a health plan which has limited office visit, or office visit which applies to the planís general medical deductible.  You can often dramatically reduce monthly premium costs by purchasing a plan which might office visits capped at 2-3 per member per year.  Donít get caught up in keeping a $10 or $20 office visit because that is the coverage you had at your prior employer.  Itís not worth it if your cost is an extra $200 per month and you only have one or two office visits per year historically.

WHAT IS COINSURANCE?:            The percentages you see listed on the plans are called Ďcoinsurance percentages.í  These are the medical expense split percentages you pay, sharing the cost with the insurance carrier.  The percentage amount you see is typically the amount you are responsible to pay after the plan deductible is paid.  If you see a coinsurance percentage listed as your benefit it usually means the plan deductible applies, so you have to pay it first, then you pay the coinsurance percentage up until you reach the plans annual out of pocket maximum.  Once you hit this annual out of pocket maximum the health insurance carrier pays 100% of the bills.  You do not pay the coinsurance percentage forever provided you are receiving treatment within the terms of the coverage contract.  Itís very important then to understand if your goal is to pay small monthly premiums and cap your risk on major medical bills how your coinsurance works in combination with deductible and annual out of pocket maximum.

 

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